Early Detection of Schizophrenia: The Prodrome Phase

Early detection of schizophrenia is often very difficult before a person starts actively hallucinating or exhibiting bizarre behavior. It can be very stressful for a patient or a loved one to hear the diagnosis of schizophrenia, particularly when it seems to come out of the blue. In this blog, I will discuss the prodromal phase of schizophrenia. This is the period of illness when symptoms first appear but often aren’t recognized. It almost always begins after puberty and is usually followed by a period of increasing symptoms along with a decline in overall functioning.

The prodrome phase usually occurs one to two years before the onset of psychotic symptoms (ex: hallucinations, paranoid delusions) in schizophrenia. The symptoms people usually have during this time aren’t very specific. Usually people report symptoms of anxiety, social isolation, difficulty making choices, and problems with concentration and attention. It is late in the prodromal phase that the positive symptoms of schizophrenia begin to emerge.

Three kinds of prodromal subgroups have been described. First, the attenuated positive symptom syndrome (APSS) features problems with communication, perception, and unusual thoughts that don’t rise to the level of psychosis. These symptoms have to occur at least once weekly for at least one month and become progressively worse over the course of a year.

Brief intermittent psychotic syndrome (BIPS) is another prodrome subgroup in which, in addition to problems with communication and perception, the person also experiences intermittent psychotic thoughts. The person experiences bizarre beliefs or hallucinations for a few minutes daily for at least one month, and for no more than three months.

The last prodromal subgroup is the so called ‘genetic risk plus functional deterioration’ group (G/D). These people are not currently psychotic but have been previously diagnosed with schizotypal personality disorder or they have a parent, sibling, or child that has been diagnosed with a psychotic disorder. They are considered part of this subgroup if in the past year they have had substantial declines in work, school, relationships, or general functionality in daily life.

Many times people see a doctor during the prodrome phase because of some of these disturbing symptoms. The problem is that these symptoms exist in many psychiatric and medical conditions. The situation can be confusing for both patients and doctors. Many people with schizophrenia are diagnosed with something else during the prodrome phase. Social withdrawal, unusual behavior, and frequent reprimands or absences from work and school are all red flags that may signify the beginning of schizophrenia. If you have any of the symptoms described here, it’s important to talk to a physician about them, particularly if you have a family member with schizophrenia or another major psychiatric disorder.